Abstract Rationale In the UK, the latest National Institute for Health and Care Excellence (NICE) guidance recommends considering a follow up chest radiograph at 6 weeks for those with risk factors for lung cancer or other underlying respiratory disease (including smokers or those over 50), persisting or deteriorating symptoms or unexplained weight loss with a shared decision reached with the patient. The supportive evidence for this is weak, there is no international consensus, and it is not clear whom might best benefit from follow up imaging thus making informed decisions challenging for patients. Methods We aimed to determine the prevalence of underlying lung cancer in people with pneumonia and the role of follow up chest imaging.We retrospectively identified discharge letters from a tertiary hospital that state “pneumonia” as a diagnosis from our Integrated Clinical Environment (ICE) database over a 3 month period for patients admitted under the respiratory and older people’s medicine team. We included those with confirmed pneumonia on the formal radiology report and with a presentation consistent with a community acquired pneumonia (CAP). Patients under the age of 50 were excluded. Results 162 patients in total were identified. Ages ranged from 50 to 104 with a median age of 83. 94 were previous or current smokers. 69 patients had a follow up imaging of which only 1 person was subsequently diagnosed with a lung malignancy which was managed with best supportive care.49 patients (30.2%) died before follow up imaging could be arranged. The average time for a follow up radiograph was 6.98 weeks. Using Spearman’s rank correlation, age strongly correlated with death prior to follow up imaging (r = 0.9, p = 0.037). There was no significant difference between smoking and never smoked populations regarding the rate of persistent consolidation identified at follow up imaging (p = 0.36, 95% CI -0.13, 0.046). Conclusion The prevalence of underlying lung malignancy identified was low (0.62%). Follow-up chest radiography for those over 50 years of age may offer limited diagnostic benefit. The associated mortality prior to follow-up with increasing age emphasises the importance of considering overall prognosis when making a shared decision plan with the patient. Further large-scale studies are needed to identify which patient populations are most likely to benefit from post-pneumonia radiographic surveillance. This abstract is funded by: None
Lee et al. (Fri,) studied this question.